AB 617 – California Health Benefit Exchange (Covered California): Appeals

AB 617 establishes an applicant’s or enrollee’s right to appeal actions, inactions, or decisions made by Covered California relating to enrollment, eligibility, or ineligibility for a state health subsidy program, for advance payment of the premium tax credits (APTC) and cost-sharing reductions, the amount of the APTC or cost-sharing or eligibility for affordable plan options in the individual market. The bill includes the right to an informal resolution prior to an appeals hearing as well as available judicial review. It also includes the right to appeal the determination of an exemption from penalties for failing to meet minimum standards for obtaining health care coverage and failure to provide timely notices. Decisions must be made within 90 days of the date the appeal is filed.

https://www.coveredca.com/PDFs/English/paper_application/FINALHearingRequestFormCC.pdf

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